PRP149: Rapid Transition to Virtual Care in Primary Care – Who Might be Left Behind?

Jonathan Shaw, MD, MS; Wendy Caceres; Marcy Winget, PhD; Ian Nelligan, MD, MPH


CONTEXT: With the COVID-19 Epidemic, where feasible, primary care systems rapidly shifted to virtual care. Stanford Primary Care was particularly well positioned, having already begun widescale integration of video visits in 2019; on March 15th it immediately pivoted the majority of care to video visits. Although all primary care physicians adopted this mode of care, it is less clear how the transition impacted patient access. Even among a well-insured, Silicon Valley-based population, the concern remains that vulnerable patients may be left behind, due to a ‘digital divide.’

OBJECTIVE: Assess rapid shift to video visits’ impact on patient access to primary care at an academic medical system, to inform future outreach efforts to patients for whom telehealth may constitute a barrier.

STUDY DESIGN: Ecological study, leveraging the “natural experiment” of COVID-19 epidemic’s induction of a rapid switch to video visits. We will use a pre-post design to compare the distribution of patient demographics and clinical indications for primary care visits pre and post COVID-19. We will explore the virtual care transition (as distinct from influence of COVID-19 impact on case mix), to evaluate key clinical diagnoses (e.g., UTIs) for which prevalence in the enrolled population is unlikely to have shifted due to COVID-19, but presentation to care might unequally be impacted for patients less able to access telehealth.

SETTING: Multi-site academic primary care (family medicine and internal medicine)

POPULATION STUDIED: An insured (public and private) adult and pediatric population
Intervention/instrument: Switch from usual primary care to predominantly video visits, on a single date

OUTCOME MEASURES: Shifts in patient and case mix in primary care visits: 1) Demographics: age, race/ethnicity, primary language, zip codes, marital status, educational level; 2) payer (private vs. public); and 3) primary diagnoses.

ANTICIPATED RESULTS: Primary care patients who are non-English speakers, publicly insured, and older might disproportionately reduce visits with our healthcare system’s sudden switch to video visits, reflecting a “digital divide” and adding to existing vulnerabilities. This work will identify those with less access when primary care shifts to virtual care and guide efforts to engage vulnerable groups in this new mode of care.

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